Endoscopic surgery involves the performance of surgical procedures through small openings and under visualization using an endoscope. Access to a target tissue is normally provided through one or more portals formed directly in the patient's body or through one or more cannulas inserted into the patient's body through small incisions. A desired surgical procedure is carried out by a surgeon through the use of elongated instruments inserted through these cannulas.
Often it is necessary to pass suture through tissue during an endoscopic procedure. This could be required to mend a tear in the tissue or to connect two or more pieces of the soft tissue to one another. Although this task is not uncommon, passing and retrieving suture through tissue can be challenging in an endoscopic or arthroscopic procedure where visualization and space is limited.
Various endoscopic instruments have been developed to pass and retrieve suture through tissue. In some instances, retrieval of suture is accomplished by simply grasping it with regular forceps or other graspers having a suture capturing aperture formed at the distal tip when the forceps jaws are closed. Some suture retrievers include simple loops which extend from the tip of an elongated tube and which can be closed upon a suture passed through the loop.
U.S. Pat. No. 5,250,054 to Li, for example, discloses a suture retriever in the form of a knot tying device having an elongated inner rod slidably situated within an elongated outer sleeve. The distal end of the inner rod is provided with a pre-formed bend and the tip has a crochet-type hook to retrieve suture. This device, however, requires a separate needle to suture tissue.
Other devices combine a needle and suture grasper in one instrument. For example, U.S. Pat. No. 5,312,432 to Trott describes an endoscopic suturing needle having an elongated tubular housing having a needle at the distal tip and a trigger mechanism to advance and retract the needle relative to the housing. The needle is pointed and flat and has a recess provided at a predetermined distance proximal to the needle tip. The recess provides an opening to capture suture material therein. This allows the needle to either push or pull suture through selected tissue. Repeated manipulation of the suture can thus create the desired surgical stitch.
Another type of suturing needle is disclosed in U.S. Pat. No. 5,222,977 to Esser in which the needle tip is stationary and a movable slide is provided to open and close a suture receiving recess spaced a predetermined distance from the needle tip.
Many of the above referenced devices are limited because the suture needle/retrieval devices have suture snares which are situated on or in line with the needle body. Consequently, the device must be manipulated close enough to the suture to guide the suture into a suture receiving recess so the recess can be closed to retain the suture. In an endoscopic procedure positioning the suture in such close proximity to the recess can be difficult.
U.S. Pat. No. 8,066,718 to Weisel et al. discloses an expandable needle suture apparatus comprising bifurcated needle portions which define a suture slot.
U.S. Pat. No. 5,499,991 to Garman discloses a suture retriever and method for manipulating suture during endoscopic surgical procedures. The suture retriever has an elongated housing provided with a solid needle tip and a lateral opening situated proximal the needle tip. A suture engaging hook is extendable through the lateral opening and away from the axis of the housing in order to snare a suture. The hook is situated at the distal end of an elongated flexible support which is pre-formed in order to enable the hook to be laterally displaced from the axis of the needle tip when the support is moved distally relative to the lateral opening. When a suture is engaged by the hook, the latter is retracted proximally in order to place and hold the suture adjacent the lateral opening.
A problem with certain hooks (such as a full circle hook), or the like, however, is that such hooks tend to increase the size of the device profile penetrating the tissue, making endoscopic surgical procedures more challenging. Adding hinged jaw mechanisms make it harder to work in the tight needle bends required to reach certain anatomical areas such as the inferior labrum. Adding such hooks at the distal end also increases the probability of inadvertently snaring tissue, and being prevented from releasing the tissue, which may damage the tissue and/or the device.
Suturing the labrum, for example, can prove challenging particularly when the tissue is severely damaged and only small areas of tissue are available to pass suture. In such cases, a novel device would be desired that could decrease the overall profile of the feature penetrating the tissue, and optimize the working profile of the instrument to improve access to the working site.
Another shortcoming with various suturing devices is that they are relatively complex to operate, making it harder for the average surgeon to utilize, and increasing the likelihood of device failure.
Accordingly, an endoscopic suturing instrument for manipulating suture through tissue which overcomes the above described shortcomings is still desirable.